Elizabeth J Renaud1, Stig Sømme2, Saleem Islam3, Danielle B Cameron4, Robert L Gates5, Regan F Williams5, Tim Jancelewicz5, Tolulope A Oyetunji6, Julia Grabowski7, Karen A Diefenbach8, Robert Baird9, Meghan A Arnold10, Dave R Lal11, Julia Shelton12, Yigit S Guner13, Ankush Gosain14, Akemi L Kawaguchi15, Robert L Ricca16, Adam B Goldin17, Roshni Dasgupta18. 1. Division of Pediatric Surgery, Department of Surgery, Warren Alpert Medical School at Brown University, Hasbro Children's Hospital, 2 Dudley Street, Suite 190, Providence, RI 02905. Electronic address: elizabeth_renaud@brown.edu. 2. Division of Pediatric Surgery, Children's Hospital of Colorado, University of Colorado, Aurora, CO. 3. Division of Pediatric Surgery, University of Florida, Gainesville, FL. 4. Department of Surgery, Boston Children's Hospital, Boston, MA. 5. Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN. 6. University of Missouri-Kansas City School of Medicine, Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO. 7. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL. 8. Department of Pediatric Surgery; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH. 9. Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre. 10. Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI. 11. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 12. Division of Pediatric Surgery, Department of Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA. 13. Department of Surgery, University of California Irvine and, Division of Pediatric General and Thoracic Surgery, Children's Hospital of Orange County. 14. Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN. 15. Department of Pediatric Surgery, Mc Govern School of Medicine at the University of Texas HSC at Houston, Houston, TX. 16. Department of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, VA. 17. APSA Outcomes Committee. 18. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH.
Abstract
BACKGROUND: The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy. METHODS: The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review. RESULTS: Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence. CONCLUSIONS: Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly 3-4).
BACKGROUND: The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy. METHODS: The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review. RESULTS: Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence. CONCLUSIONS: Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly 3-4).
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